Hepatitis C - Or Its Treatment - Can Cause Fatigue

Q:  I was diagnosed with Hepatitis C in 1999. I have received the interferon treatments 3 times: the first couple times for 4 and 6 months without much response, and then a third time 2 years ago.

On the third try, I had 12 months of interferon, with a good response (my viral load is "undetectable") but ever since, I have felt overwhelming fatigue.

My doctors have answered my complaint with comments like "we don't know enough about hepatitis C to know what this is about," "you know you're getting older" (I'm 47), and "maybe you are depressed."

I'm not depressed, but I will be if I can't get my energy back. Is this due to the interferon therapy or is this "hepatitis C syndrome?" Any suggestions?

A:  Several different viruses cause viral hepatitis, an inflammation of the liver. One of these is the hepatitis C virus, which is spread primarily through contact with infected blood.

Hepatitis symptoms include:

• jaundice (yellowing of the skin and eyes)
• fatigue
• abdominal pain
• loss of appetite
• nausea
• vomiting
• diarrhea
• low grade fever
• headache

All the hepatitis viruses cause acute, or short-term, viral hepatitis. But the hepatitis B, C, and D viruses can also cause chronic hepatitis, in which the infection is prolonged, sometimes lifelong. Unfortunately, there is no vaccine against hepatitis C.

Now, the good news: Dr. Jose Franco, Associate Professor of Medicine (Gastroenterology and Hepatology) and Medical Director of Liver Transplantation at the Medical College of Wisconsin, tells me that only about a third of people with your type of hepatitis C respond so completely to the medications used to attack the virus (such as interferon). So, you're lucky to have "undetectable" virus levels.

However, notes Dr. Franco, who practices at the Froedtert & The Medical College of Wisconsin Gastroenterology and Hepatology Clinic, killing the hepatitis C virus can only protect your liver from future damage due to the virus. If your liver was already scarred when you started therapy, you may be fatigued from the liver problems that were present before the interferon.

Dr. Franco has other ideas to explain your fatigue: other medications that are often used with interferon (such as ribavirin) can cause anemia, and interferon can cause a poorly functioning thyroid gland.

Interferon itself can cause low energy, but this side effect usually goes away when you are not taking the medication. Antidepressants can effectively treat interferon-related fatigue, even when the patient is not "depressed" in the usual sense.

So, I think it's worth double-checking for treatable causes of fatigue such as anemia and thyroid disorders. And talk with your doctor about treatments for depression (even if you aren't clinically depressed).

Much of the counseling doctors give when caring for people with depression is good advice for all people, especially those with fatigue. Seek out useful strategies for coping with chronic symptoms, for stress-reduction, and study up on how diet and exercise can bring energy. Part of this search may include finding doctors that makes you feel like they're listening to you.

Julie L. Mitchell, MD, MS, is an Assistant Professor of Medicine at the Medical College of Wisconsin. She practices at the Froedtert & The Medical College of Wisconsin General Internal Medicine Clinic - East. Her column appears in the Milwaukee Journal-Sentinel.